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Workshop Abstracts

What's a realist configuration? Deciding which causal configuration to use, how and why


Esther De Weger

Dutch Nationational Institute For Public Health And The Environment, NL
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Integrated care interventions operate in complex contexts. The realist evaluation (RE) approach was first developed based on the idea that, in order for studies to be useful to practice-leaders and policymakers, studies should not only indicate whether an intervention works or not, but should highlight ‘what works, how, in which contexts, and for whom’.  RE studies use context-mechanism-outcome configurations to express causal explanations and examine how professionals can implement interventions successfully within their own contexts. The interactive workshop aims to introduce RE, provide participants with hands-on experience, and the opportunity to exchange ideas. 


Building configurations is key to data analysis and theory development in realist studies. When the approach was first developed, only context-mechanism-outcome configurations (CMOs) were used to express causal explanations. However, increasingly realist studies have been conducted using different variations of the heuristic, such as strategy-context-mechanism-outcome configurations (SCMO) or intervention-context-actor-mechanism-outcome configurations (ICAMO). Researchers have highlighted a lack of methodological guidance regarding which additional explanatory factors can be included in configurations (e.g. strategies, actors). The workshop will introduce the RE approach, highlighting presenters’ own experiences of conducting realist studies. Afterwards, in an interactive group-session participants will learn how to apply the approach and formulate configurations.

Aims & objectives

The main objectives are to introduce two realist studies, one using CMOs and one using SCMOs, thus providing participants with clear guidance on how the RE approach, and realist configurations specifically, can be applied. By sharing our experiences of conducting realist studies, we will unpack when and why additional explanatory factors can be added to the ‘original’ context-mechanism-outcome configuration.



Target audience

Our target audience includes researchers and commissioners interested in RE. Based on presenters’ own realist studies, participants will formulate their own realist configurations in group-sessions.

Learnings/take away

•              Participants will gain an overview of RE, including recommendations and important considerations for operationalizing the approach.

•              Through group-sessions, participants will gain experience in the different ways realist studies can be conducted and configurations can be expressed.


The session will be provided by Natascha van Vooren & Esther de Weger and applies the following format:

•              Introduction of RE principles and the role of configurations in realist studies (10 minutes);

•              Share presenters’ own experiences of conducting realist studies, specifically highlighting the use of different configuration types (e.g. CMO, SCMO, ICAMO) (10 minutes)

•              Provide guidance and recommendations regarding the use of different configuration types (10 minutes)

•              World café interactive session (45 minutes): participants will be divided into groups and will be provided with realist study examples. For each study example participants will be invited:

o             to decide which configuration type to use;

o             to formulate their own configurations;

o             to discuss how and why they choose this approach, the benefits & drawbacks

Participants will be asked to write down the main discussion points on a flipchart. After 20 minutes, participants will rotate to a different table and work on a different study example. Plenary session: to discuss experiences and choices (15 minutes)

•              Preferred length: 90 minutes

How to Cite: De Weger E. What's a realist configuration? Deciding which causal configuration to use, how and why. International Journal of Integrated Care. 2021;21(S1):368. DOI:
Published on 01 Sep 2021.
Peer Reviewed


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